Critical analysis of the current data on the normal endometrial microbiome

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Abstract

A search of literature sources was carried out in the PabMed/MedLine, eLibrary databases for the period 2019–2024 and a review of the endometrial microbiota in women of reproductive age without uterine pathology was conducted. Single studies of the uterine microbiome in healthy women were found. The endometrium is supposed to contain a very low microbial mass, which prevents microorganisms from being cultivated. Currently, next generation sequencing is widely used to evaluate the 16S ribosomal RNA gene sequence, that is justified by the universality of bacteria research method. However, 16S rRNA sequencing has significant limitations: firstly, the method is not applicable to viruses and fungi; secondly, the results are calculated using special algorithms, and the unit of measurement is an operational taxonomic unit, more often corresponding to the genus and not necessarily identical to the cultivated microorganism. The data on the presence and composition of the endometrial microbiota of the normal uterus are contradictory. This may be due to the lack of a single universal approach to diagnosis and there is no method for obtaining endometrial samples without contamination. Metatranscriptomic analysis of the endometrium in healthy women showed the presence of metabolically active microorganisms in normal endometrium in very low numbers without dominance of Lactobacillus.

Conclusion: Scientific findings on the microbiome of the normal endometrium continue to accumulate. There is still an unproven association of the presence and relative abundance of Lactobacillus in the endometrium with the rate of clinical pregnancy and live birth, including those after the use of assisted reproductive technologies.

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About the authors

Alena I. Baranouskaya

Belarusian State Medical University

Author for correspondence.
Email: elena_baranovska@mail.ru
ORCID iD: 0000-0002-2116-4675

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology

Belarus, Minsk

Aliaksandr N. Voronetsky

Belarusian State Medical University

Email: anvoron@mail.ru
ORCID iD: 0000-0001-7091-376X

PhD, Associate Professor at the Department of Pediatric Surgery

Belarus, Minsk

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